Haematology Society of Australia and New Zealand
Recommendations from the Haematology Society of Australia and New Zealand on thrombophilia, lymphoma, venous thromboembolism, leukaemia & thrombocytopenic purpura. Founded in 1998, The Haematology Society of Australia and New Zealand (HSANZ) seeks to promote, foster, develop and assist the study and application of information concerning haematology, and to promote improved standards, interest and research in all aspects of haematology.
5.
Do not treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a platelet count <30,000/L without risk factors for bleeding.
Treatment for immune thrombocytopenic purpura (ITP) should be aimed at treating and preventing bleeding episodes and improving quality of life. Unnecessary treatment exposes patients to potentially serious treatment side effects and can be costly, with little expectation of clinical benefit. Unless they are preparing for surgery or invasive procedure, or have significant additional risk factor for bleeding , ITP treatment is rarely indicated in adult patients with platelet counts greater than 30,000/L. In patients preparing for surgery or other invasive procedures, short-term treatment may be indicated to increase the platelet count prior to the planned intervention and during the immediate post-operative period.
Supporting evidence
Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117(16):4190-207.
How this list was made
The Haematology Society of Australia and New Zealand (HSANZ) council, which includes 9 state representatives, convened to form the working group to produce a ‘top 5’ list for haematology.
Drawing on the list produced by the American and Canadian Societies of Haematology, the working group compiled a list of 5 clinical practices in haematology which may be overused, inappropriate or of limited effectiveness in a given clinical context.
This list was then sent out to all HSANZ members seeking feedback on whether these items fully captured the concerns of clinicians in an Australasian haematology medicine context and if not, whether any items should be omitted and/or new items added.
The criteria used to rate the practices were strength of evidence, significance in haematology and whether haematologists could make a difference in influencing the incidence of the practice in question.
Feedback on the items and the recommendations was received from 11 institutional haematology departments (following intradepartmental consultation) as well as an additional 10 individuals.
Based on these responses, the top 5 items were selected and finalised.
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1
Do not conduct thrombophilia testing in adult patients under the age of 50 years unless the first episode of venous thromboembolism (VTE):
- occurs in the absence of a major transient risk factors (surgery, trauma, immobility),
- occurs in the absence of oestrogen-provocation,
- occurs at an unusual site
- occurs in the absence of a major transient risk factors (surgery, trauma, immobility),
- 2 Limit surveillance computed tomography (CT) scans in asymptomatic patients with confirmed complete remission following curative intent treatment for aggressive lymphoma – except for patients on a clinical trial
- 3 Do not extend anticoagulation beyond 3 months for a patient with a non-extensive, index venous thromboembolic event (VTE), which occurred in the setting of a major, transient risk factor
- 4 Do not perform baseline or routine surveillance CT scans or bone marrow biopsy in patients with asymptomatic early stage chronic lymphocytic leukaemia (CLL)
- 5 Do not treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a platelet count <30,000/L without risk factors for bleeding.